In vivo colonoscopic optical coherence tomography for transmural inflammation in inflammatory bowel disease

Bo Shen, Gregory Zuccaro, Terry L. Gramlich, Natalie Gladkova, Patricia Trolli, Margaret Kareta, Conor P. Delaney, Jason T. Connor, Bret A. Lashner, Charles L Bevins, Felix Feldchtein, Feza H. Remzi, Marlene L. Bambrick, Victor W. Fazio

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Background & Aims: Transmural inflammation, a distinguishing feature of Crohn's disease (CD), cannot be assessed by conventional colonoscopy with mucosal biopsy. Our previous ex vivo study of histology-correlated optical coherence tomography (OCT) imaging on colectomy specimens of CD and ulcerative colitis (UC) showed that disruption of the layered structure of colon wall on OCT is an accurate marker for transmural inflammation of CD. We performed an in vivo colonoscopic OCT in patients with a clinical diagnosis of CD or UC using the previously established, histology-correlated OCT imaging criterion. Methods: OCT was performed in 40 patients with CD (309 images) and 30 patients with UC (292 images). Corresponding endoscopic features of mucosal inflammation were documented. Two gastroenterologists blinded to endoscopic and clinical data scored the OCT images independently to assess the feature of disrupted layered structure. Results: Thirty-six CD patients (90.0%) had disrupted layered structure, whereas 5 UC patients (16.7%) had disrupted layered structure (P <. 001). Using the clinical diagnosis of CD or UC as the gold standard, the disrupted layered structure on OCT indicative of transmural inflammation had a diagnostic sensitivity and specificity of 90.0% (95% CI: 78.0%, 96.5%) and 83.3% (95% CI: 67.3%, 93.3%) for CD, respectively. The κ coefficient in the interpretation of OCT images was 0.80 (95% CI: 0.75, 0.86, P <. 001). Conclusions: In vivo colonoscopic OCT is feasible and accurate to detect disrupted layered structure of the colon wall indicative of transmural inflammation, providing a valuable tool to distinguish CD from UC.

Original languageEnglish (US)
Pages (from-to)1080-1087
Number of pages8
JournalClinical Gastroenterology and Hepatology
Volume2
Issue number12
DOIs
StatePublished - Dec 2004
Externally publishedYes

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Optical Coherence Tomography
Inflammatory Bowel Diseases
Crohn Disease
Inflammation
Ulcerative Colitis
Histology
Colon
Colectomy
Colonoscopy
Biopsy
Sensitivity and Specificity

ASJC Scopus subject areas

  • Gastroenterology

Cite this

In vivo colonoscopic optical coherence tomography for transmural inflammation in inflammatory bowel disease. / Shen, Bo; Zuccaro, Gregory; Gramlich, Terry L.; Gladkova, Natalie; Trolli, Patricia; Kareta, Margaret; Delaney, Conor P.; Connor, Jason T.; Lashner, Bret A.; Bevins, Charles L; Feldchtein, Felix; Remzi, Feza H.; Bambrick, Marlene L.; Fazio, Victor W.

In: Clinical Gastroenterology and Hepatology, Vol. 2, No. 12, 12.2004, p. 1080-1087.

Research output: Contribution to journalArticle

Shen, B, Zuccaro, G, Gramlich, TL, Gladkova, N, Trolli, P, Kareta, M, Delaney, CP, Connor, JT, Lashner, BA, Bevins, CL, Feldchtein, F, Remzi, FH, Bambrick, ML & Fazio, VW 2004, 'In vivo colonoscopic optical coherence tomography for transmural inflammation in inflammatory bowel disease', Clinical Gastroenterology and Hepatology, vol. 2, no. 12, pp. 1080-1087. https://doi.org/10.1016/S1542-3565(04)00621-4
Shen, Bo ; Zuccaro, Gregory ; Gramlich, Terry L. ; Gladkova, Natalie ; Trolli, Patricia ; Kareta, Margaret ; Delaney, Conor P. ; Connor, Jason T. ; Lashner, Bret A. ; Bevins, Charles L ; Feldchtein, Felix ; Remzi, Feza H. ; Bambrick, Marlene L. ; Fazio, Victor W. / In vivo colonoscopic optical coherence tomography for transmural inflammation in inflammatory bowel disease. In: Clinical Gastroenterology and Hepatology. 2004 ; Vol. 2, No. 12. pp. 1080-1087.
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abstract = "Background & Aims: Transmural inflammation, a distinguishing feature of Crohn's disease (CD), cannot be assessed by conventional colonoscopy with mucosal biopsy. Our previous ex vivo study of histology-correlated optical coherence tomography (OCT) imaging on colectomy specimens of CD and ulcerative colitis (UC) showed that disruption of the layered structure of colon wall on OCT is an accurate marker for transmural inflammation of CD. We performed an in vivo colonoscopic OCT in patients with a clinical diagnosis of CD or UC using the previously established, histology-correlated OCT imaging criterion. Methods: OCT was performed in 40 patients with CD (309 images) and 30 patients with UC (292 images). Corresponding endoscopic features of mucosal inflammation were documented. Two gastroenterologists blinded to endoscopic and clinical data scored the OCT images independently to assess the feature of disrupted layered structure. Results: Thirty-six CD patients (90.0{\%}) had disrupted layered structure, whereas 5 UC patients (16.7{\%}) had disrupted layered structure (P <. 001). Using the clinical diagnosis of CD or UC as the gold standard, the disrupted layered structure on OCT indicative of transmural inflammation had a diagnostic sensitivity and specificity of 90.0{\%} (95{\%} CI: 78.0{\%}, 96.5{\%}) and 83.3{\%} (95{\%} CI: 67.3{\%}, 93.3{\%}) for CD, respectively. The κ coefficient in the interpretation of OCT images was 0.80 (95{\%} CI: 0.75, 0.86, P <. 001). Conclusions: In vivo colonoscopic OCT is feasible and accurate to detect disrupted layered structure of the colon wall indicative of transmural inflammation, providing a valuable tool to distinguish CD from UC.",
author = "Bo Shen and Gregory Zuccaro and Gramlich, {Terry L.} and Natalie Gladkova and Patricia Trolli and Margaret Kareta and Delaney, {Conor P.} and Connor, {Jason T.} and Lashner, {Bret A.} and Bevins, {Charles L} and Felix Feldchtein and Remzi, {Feza H.} and Bambrick, {Marlene L.} and Fazio, {Victor W.}",
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T1 - In vivo colonoscopic optical coherence tomography for transmural inflammation in inflammatory bowel disease

AU - Shen, Bo

AU - Zuccaro, Gregory

AU - Gramlich, Terry L.

AU - Gladkova, Natalie

AU - Trolli, Patricia

AU - Kareta, Margaret

AU - Delaney, Conor P.

AU - Connor, Jason T.

AU - Lashner, Bret A.

AU - Bevins, Charles L

AU - Feldchtein, Felix

AU - Remzi, Feza H.

AU - Bambrick, Marlene L.

AU - Fazio, Victor W.

PY - 2004/12

Y1 - 2004/12

N2 - Background & Aims: Transmural inflammation, a distinguishing feature of Crohn's disease (CD), cannot be assessed by conventional colonoscopy with mucosal biopsy. Our previous ex vivo study of histology-correlated optical coherence tomography (OCT) imaging on colectomy specimens of CD and ulcerative colitis (UC) showed that disruption of the layered structure of colon wall on OCT is an accurate marker for transmural inflammation of CD. We performed an in vivo colonoscopic OCT in patients with a clinical diagnosis of CD or UC using the previously established, histology-correlated OCT imaging criterion. Methods: OCT was performed in 40 patients with CD (309 images) and 30 patients with UC (292 images). Corresponding endoscopic features of mucosal inflammation were documented. Two gastroenterologists blinded to endoscopic and clinical data scored the OCT images independently to assess the feature of disrupted layered structure. Results: Thirty-six CD patients (90.0%) had disrupted layered structure, whereas 5 UC patients (16.7%) had disrupted layered structure (P <. 001). Using the clinical diagnosis of CD or UC as the gold standard, the disrupted layered structure on OCT indicative of transmural inflammation had a diagnostic sensitivity and specificity of 90.0% (95% CI: 78.0%, 96.5%) and 83.3% (95% CI: 67.3%, 93.3%) for CD, respectively. The κ coefficient in the interpretation of OCT images was 0.80 (95% CI: 0.75, 0.86, P <. 001). Conclusions: In vivo colonoscopic OCT is feasible and accurate to detect disrupted layered structure of the colon wall indicative of transmural inflammation, providing a valuable tool to distinguish CD from UC.

AB - Background & Aims: Transmural inflammation, a distinguishing feature of Crohn's disease (CD), cannot be assessed by conventional colonoscopy with mucosal biopsy. Our previous ex vivo study of histology-correlated optical coherence tomography (OCT) imaging on colectomy specimens of CD and ulcerative colitis (UC) showed that disruption of the layered structure of colon wall on OCT is an accurate marker for transmural inflammation of CD. We performed an in vivo colonoscopic OCT in patients with a clinical diagnosis of CD or UC using the previously established, histology-correlated OCT imaging criterion. Methods: OCT was performed in 40 patients with CD (309 images) and 30 patients with UC (292 images). Corresponding endoscopic features of mucosal inflammation were documented. Two gastroenterologists blinded to endoscopic and clinical data scored the OCT images independently to assess the feature of disrupted layered structure. Results: Thirty-six CD patients (90.0%) had disrupted layered structure, whereas 5 UC patients (16.7%) had disrupted layered structure (P <. 001). Using the clinical diagnosis of CD or UC as the gold standard, the disrupted layered structure on OCT indicative of transmural inflammation had a diagnostic sensitivity and specificity of 90.0% (95% CI: 78.0%, 96.5%) and 83.3% (95% CI: 67.3%, 93.3%) for CD, respectively. The κ coefficient in the interpretation of OCT images was 0.80 (95% CI: 0.75, 0.86, P <. 001). Conclusions: In vivo colonoscopic OCT is feasible and accurate to detect disrupted layered structure of the colon wall indicative of transmural inflammation, providing a valuable tool to distinguish CD from UC.

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